Efficacy of a Peer-Led, Recovery-Oriented Shared Decision-Making System: A Pilot Randomized Controlled Trial

Abstract

The shared decision-making system appeared to partly improve patients' perceptions of communication and relationships with doctors but did not have a significant effect on other patient-level outcomes.

Shared decision making for adults with severe mental illness: A concept analysis

“…The goal for the decision is not granted by the health professionals unilaterally, but set together with the service users through discussion (Matthias et al, 2017). It is the user's own goal, which is individual recovery-oriented (Matthias et al, 2017;Paudel et al, 2018;Woltmann, Wilkniss, Teachout, McHugo, & Drake, 2011;Yamaguchi et al, 2017). Thereafter, both parties share the service user's identified personal goal (Finnerty et al, 2019;Paudel et al, 2018;Yamaguchi et al, 2017).…”

Combining technical and expert-by-experience knowledge in the quest for personal recovery from bipolar disorder: a qualitative study

“…Yet, there has been virtually no effort to develop strategies for integrating technical and expert-by-experience knowledge. At the same time, the evidence for peer support services in the mental health arena is increasing accumulatively in countries acknowledged to have advanced psychiatric care, including the US, Australia, and, more recently, Hong Kong [14, 19, 21, 24, 52]. For example, a recent randomized controlled trial conducted in Germany found that participants with severe mental illnesses in one-to-one peer support services showed statistically significant improvements in self-efficacy, compared with the control group [20].…”

“…Perhaps cultural issues in knowledge acquisition are unique to the development of peer support services in Hong Kong and other non-Western countries in general [44]. A recent pilot randomized controlled trial conducted in Tokyo, Japan, found that participants in a PSW-led shared decision-making intervention group reported a significantly more positive view of their relationship with their treating psychiatrists, compared to the control group [24]. Among some participants of the present study, only regular mental health workers were considered as professionals, knowledge was heavily organized in a hierarchal fashion (e.g., medical or nursing professionals hold technical knowledge and pass it to patients; see Table 1) and was not co-constructed, and advice from PSWs was to be treated with caution (see Results: Theme 2, SU24).…”

“…Several effectiveness studies and reviews have shown that peer support services are able to instill a sense of hope, control, and self-efficacy; to enhance self-care, relationships with service providers, and participation in treatment; to increase a sense of belonging to a community and satisfaction with life; and to reduce psychotic and mood symptoms among clients with mental illness [18–23]. Recent studies on peer support services focus on three main areas: 1) conducting high-quality clinical trials [14, 17, 20, 23, 24]; 2) studying what works to achieve an organizational transformation or cultural workplace shift to better implement peer support services [14, 23, 25, 26]; and 3) deepening our understanding of the mechanism of how PSWs work [14, 21, 27, 28]. One of the mechanism-related questions is as follows: How do clients conceptualize the knowledge derived from mental health professionals and PSWs to manage their BD?…”

Associations between provider communication and personal recovery outcomes

“…Nonetheless, our analyses did control for levels of psychological distress accounting for potential differences in mental illness severity among study participants obtaining services across different mental health care settings. Finally, provider communication overlaps with other areas such as working alliance [49–51] and shared decision-making [52, 53] that have been linked to personal recovery outcomes; additional research is needed to better understand how these consumer experiences relate to one another and personal recovery. Further, some have expressed concerns that consumer experience surveys may tap into providers’ compliance with patient expectations or preferences even when they may be contraindicated (e.g., stopping medication) [54, 55], highlighting the potentially complex relationship between consumer experiences, the delivery of evidence-based care, and personal recovery.…”